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Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

The federal government has had a long-standing commitment to supporting healthy relationships and stable families. In the mid-1990s, Congress created the Temporary Assistance for Needy Families (TANF) block grant, which had the formation and maintenance of two-parent families as one of its core purposes. TANF provided states with the funding and flexibility to support activities to promote healthy marriage. Beginning in the mid-2000s, the federal government began providing additional funding specifically to support healthy marriage and relationship education (HMRE) services. The Office of Family Assistance (OFA) in the Administration for Children & Families (ACF), U.S. Department of Health and Human Services oversees these funds and distributes them through a set of competitive multi-year grants to organizations nationwide. OFA made the most recent round of HMRE grant awards in September 2015. These grants support HMRE services for a mix of populations, including youth in high school, individual adults, and adult couples. (Author abstract)

The federal government has had a long-standing commitment to supporting healthy relationships and stable families. In the mid-1990s, Congress created the Temporary Assistance for Needy Families (TANF) block grant, which had the formation and maintenance of two-parent families as one of its core purposes. TANF provided states with the funding and flexibility to support activities to promote healthy marriage. Beginning in the mid-2000s, the federal government began providing additional funding specifically to support healthy marriage and relationship education (HMRE) services. The Office of Family Assistance (OFA) in the Administration for Children & Families (ACF), U.S. Department of Health and Human Services oversees these funds and distributes them through a set of competitive multi-year grants to organizations nationwide. OFA made the most recent round of HMRE grant awards in September 2015. These grants support HMRE services for a mix of populations, including youth in high school, individual adults, and adult couples. (Author abstract)

Mathematica and Casey Family Programs have published the final report from a project linking child welfare and Medicaid data to conduct analyses to understand types of high service use and to identify factors predictive of high service use among children in foster care. The study identifies distinct types of high service users and how both child welfare and Medicaid data can be used to predict which children may be likely to experience high degrees of placement instability. The study was conducted in partnership with partners in two states—Tennessee’s Department of Children’s Services and TennCare, and Florida’s Department of Children and Families, Agency for Health Care Administration, and Eckerd Kids. The goal of the project is to help child welfare, Medicaid and other service providing agencies better coordinate service delivery to prevent undesirable outcomes for children and to improve effectiveness and efficiency. (Author abstract)

Mathematica and Casey Family Programs have published the final report from a project linking child welfare and Medicaid data to conduct analyses to understand types of high service use and to identify factors predictive of high service use among children in foster care. The study identifies distinct types of high service users and how both child welfare and Medicaid data can be used to predict which children may be likely to experience high degrees of placement instability. The study was conducted in partnership with partners in two states—Tennessee’s Department of Children’s Services and TennCare, and Florida’s Department of Children and Families, Agency for Health Care Administration, and Eckerd Kids. The goal of the project is to help child welfare, Medicaid and other service providing agencies better coordinate service delivery to prevent undesirable outcomes for children and to improve effectiveness and efficiency. (Author abstract)

This brief summarizes key characteristics of programs funded through the Personal Responsibility Education Program (PREP) that reported at least half of the youth they served were in foster care. PREP, which aims to reduce teen pregnancies, sexually transmitted infections, and associated risk behaviors, is administered by the Family and Youth Services Bureau within the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services. Funding is awarded to states and territories through formula grants (State PREP), and through a competitive process to tribes and tribal entities (Tribal PREP) and to direct service providers in states and territories that did not take State PREP funding (Competitive PREP).

Purpose

This brief is one in a series that will inform stakeholders and the public about the PREP program.

Key Findings and Highlights

Forty-six programs across 16 states reported primarily serving youth in foster care. These programs served about...

Introduction

This brief summarizes key characteristics of programs funded through the Personal Responsibility Education Program (PREP) that reported at least half of the youth they served were in foster care. PREP, which aims to reduce teen pregnancies, sexually transmitted infections, and associated risk behaviors, is administered by the Family and Youth Services Bureau within the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services. Funding is awarded to states and territories through formula grants (State PREP), and through a competitive process to tribes and tribal entities (Tribal PREP) and to direct service providers in states and territories that did not take State PREP funding (Competitive PREP).

Purpose

This brief is one in a series that will inform stakeholders and the public about the PREP program.

Key Findings and Highlights

Forty-six programs across 16 states reported primarily serving youth in foster care. These programs served about 5,000 youth each year, largely through foster care settings. Most youth in these programs reported being White or Black or African American, and most were ages 15 to 18. About two-thirds of youth reported being sexually active before entering the program. After PREP, more than one-third of the youth in these programs reported they were less likely to have sex in the next six months, and a large majority reported they were more likely to use condoms and birth control if they have sex.

Methods

PREP grantees submit performance measures data to ACF each year. These findings are based on performance measures data submitted by State PREP, Tribal PREP, and Competitive PREP grantees for the 2014–2015 reporting period. (Author introduction)

This video and its accompanying presentation slides are from the 2018 Research and Evaluation Conference on Self-Sufficiency (RECS). The session began with an overview of the Program for the International Assessment of Adult Competencies (PIAAC) population-level data and how analysis of new education-employment variables can help promote young adults’ self-sufficiency. Then, two presentations featured Year Up, one of the nation’s foremost programs for low-income youth. Evaluation findings from both Year Up’s core model and its Professional Training Corps model were presented. Marsha Silverberg (U.S. Department of Education) served as the moderator. Raphael Rosenblatt (Year Up) served as the discussant. (Author introduction)

This video and its accompanying presentation slides are from the 2018 Research and Evaluation Conference on Self-Sufficiency (RECS). The session began with an overview of the Program for the International Assessment of Adult Competencies (PIAAC) population-level data and how analysis of new education-employment variables can help promote young adults’ self-sufficiency. Then, two presentations featured Year Up, one of the nation’s foremost programs for low-income youth. Evaluation findings from both Year Up’s core model and its Professional Training Corps model were presented. Marsha Silverberg (U.S. Department of Education) served as the moderator. Raphael Rosenblatt (Year Up) served as the discussant. (Author introduction)